Journal Publication in an Emergency
The Public Library of Science (PLoS Medicine) published a really great editorial the other day on public health emergencies. Traditionally, strictly public health emergencies have been caused by some novel disease spreading unchecked in some populace. Responding to the emergency is inevitably delayed as epidemiologists, lab workers and doctors struggle to identify the disease, quantify and understand the epidemiology of the disease (who gets it, how do they get it, how do they fight it, what does it do to their bodies, etc.), and then identify some countermeasure.
While this is going on, people continue to get sick and could die.
Now, imagine that some novel virus is spreading, sickening and killing people. And good doctors, epidemiologists and lab workers have studied the disease and have answered one of the critical questions above. One that will either identify a countermeasure or identify a potentially fertile population for the virus to explode in or figure out how the disease is transmitted.
And they write it up.
And send it to a journal for publication.
And it gets reviewed and denied.
And submitted to another journal.
And it gets reviewed and published.
It’s not so ridiculous. It’s happened in the past, just this past year, in fact. The PLoS editorial talks about the article, “Association between the 2008–09 Seasonal Influenza Vaccine and Pandemic H1N1 Illness during Spring-Summer 2009: Four Observational Studies from Canada,” which went through just that series of events. And the last two steps took five months (November to April).
If you don’t remember that study, it was the one that found an association between 2008-2009 seasonal flu vaccination and infection with H1N1 influenza. What a potentially useful bit of information to have when planning out a response! People who got the flu shot last year might be more likely to catch H1N1 influenza!
How many flu cases were we seeing during the week of 6 April? Less than 100 across the country. Not so much response planning going on then, if I remember correctly.
What should researchers do then? Publication in a top-flight journal connotes authority and certifies rigorous study. But, is that level of authority necessary if the findings aren’t published until after the disease outbreak ends?
Take, for example, the other disease mentioned in the PLoS editorial: SARS. Another article published this month looks at the number of SARS-related articles published in 2003/2004 — at the height of the SARS outbreak.
[T]he authors note, “Only 22% of the studies were submitted, 8% accepted, and 7% published during the epidemic.”
Not a great track record for rapidly sharing information, as the PLoS editorial says.
Now, sure, people are getting sick and dying during these delays, and that’s terrible. As a planner, though, I’m more concerned with the decisions being made by hospitals and public health departments. Decisions that very well could prolong the outbreak. All for a lack of good data. Because it’s unavailable while waiting to be published.
The editorial notes some possible other avenues for disseminating research:
Journals are, of course, only one source of information for health and scientific research, and may be over-relied upon, especially in emergencies. International bodies such as WHO provided efficient regular  updates during both emergencies, as did local health bodies such as the Health Protection Agency in the UK  and the Centers for Disease Control in the US . Face-to-face meetings and teleconferences provide further mechanisms for sharing of information, and when linked to sharing of resources were powerful catalysts for accelerating influenza research. PLoS itself launched an experimental site, PLoS Currents: Influenza (http://knol.google.com/k/plos-currents-influenza# ) for early sharing of information after only the lightest of moderation.
The fact remains, though, that something needs to be done to facilitate dissemination of research findings quickly (while providing proper credit), ethically and with some manner of review. If SARS continued unabated, or H1N1 influenza was as deadly as we initially feared, answering this question could have been one of the most important things done in response.